Provider Demographics
NPI:1962493411
Name:BOURGEOIS, FABIENNE CATYA (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIENNE
Middle Name:CATYA
Last Name:BOURGEOIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:S50 - 901
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1103
Practice Address - Fax:978-745-9024
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA222023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics